Creating a single point of referral and standardized care pathway for patients with melanoma to improve access to care.

Abstract

127 Background: Access to care is often a challenge for healthcare organizations – especially as pressures on time increase and workforce availability decreases – and is often complex to solve. In this quality improvement (QI) initiative, a team from a rural academic medical center deployed the Lean Six Sigma approach to develop a two-pronged method that reduced the median time to first visit for new melanoma patients. Methods: The project team deployed the Define, Measure, Analyze, Improve, and Control (DMAIC) processes to address access for melanoma patients after the healthcare organization set a goal that 55% of new specialty care patients be seen within 10 days. Define: Concern was raised by the melanoma clinical care team that the lack of a well-defined and standardized referral workflow for melanoma patients could delay patient care. Measure: Data from the electronic medical record (EMR) indicated that only 31% of incoming referrals were seen within 10 days, and the median number of days to first visit was 15, or 50% over the organizational standard. Analyze: Analysis found considerable waste in the existing referral system. First, untrained staff made referral and routing decisions, meaning patients could potentially be seen by inappropriate departments based on the assessment of those not specialized in melanoma care and treatment. This led to the second area of waste: rework. Every referral had to be reviewed by multiple staff in several departments to ensure the referral made was appropriate based on the characteristics of disease. This was a very labor-intensive processes that allowed too many patients to “slip through the cracks” of the system. Improve: Two interventions were deployed to address the identified waste. First, a centralized referral point for all melanomas monitored by the Program Coordinator. Second, a referral questionnaire developed by an interdisciplinary team to guide where routine cases should be referred. Early results show that the interventions had marked impact on the time to first appointment for all referrals, whether originating inside of the organization or out. After the intervention 54% of newly referred patients were seen within 10 days. Results: Control: A standard report was built to support the project team in monthly monitoring of the KPI, days from referral to patient seen. The report is monitored by a dedicated Program Coordinator who can escalate any issues during regular interdisciplinary care team meetings. Conclusions: Improvements in access can be achieved by adopting standard work that is targeted to reduce waste in the referral workflow. The model developed by this QI initiative is easily replicable and may be especially useful for interdisciplinary teams who provide care to complex diseases.[Table: see text]